Since January 1983, silicone gastric banding (SGB) has been used with very low morbidity in 311 extremely obese patients to produce and maintain significant weight loss for as long as 7 years. A small meal-sizing pouch with reinforced small stoma is created with placement of the silicone band around the stomach. The basic operative technique involving no cutting or crushing of either the stomach or the small intestines has not changed. Strict quality control of the banding is permitted by specialty designed calibration devices and other instruments. To permit correction of changes in stoma diameter occurring with the passage of time, the band was modified in 1986 by adding an adjustable portion (stoma adjustable silicone gastric banding or SASGB). Adjustment to proper size is done percutaneously through the injection port. SASGB allows correction of most stoma-related problems non-operatively and significantly improved weight loss. One-hundred and seventy three original SGB patients (125 primary, 48 conversion) and 138 SASGB patients (93 primary, 45 conversion) were operated. At 60 months, 65 primary SGB patients averaged 47% excess weight loss (EWL). At 36 months, average EWL was significantly greater for 37 primary SASGB patients than four 94 primary SGB (64.3% vs 49.3%, p = 0.01); 84% of SASGB patients had EWL > and 57% achieved EWL > 60%. SASGB generates weight loss comparable to that produced by more extensive bariatric procedures. Excellent weight loss and maintenance combined with the stoma size non-surgical adjustment ability makes SASGB attractive for use in treating bariatric patients.